Tough Waves on Soft Spots

26. February 2010

The market is full of things against erectile dysfunction: Pills, pumps and psychoanalysis are supposed to help up weakening loins. Now scientists have tested yet another therapeutic approach: They want to breathe new life into the loins by using shock waves.

There is a whole bunch of therapies dead sure against erectile dysfunction – per definition “the ongoing inability to reach or maintain a penile erection sufficient for a satisfactory sexual intercourse” – at least if you believe all the eMail messages stuffing up not only men’s mail boxes. Reliable information on this topic you will find in relevant guidelines. According to the Deutschen Gesellschaft für Neurologie (German Association for Neurology, DGN) 2.3 percent of all men in their third life decade and 53.4 percent in their seventh decade suffer from it. For the pharmacotherapy of ED, the DGN for example names in addition to the 5-phosphodiesterase-inhibitors Apomorphin, Yohimbin and local pharmacotherapeutics like MUSE and SKAT as potential therapy options and also local aids such as vacuum pumps and local electrotherapy.

Weak waves making men strong

Extracorporal shock waves like those applied for lithotripsy might help as well, just with a lot less energy. At least Yoram Vardi, head of a urological department at the Rambam Medical Center in Haifa, Israel, alleged that during the 12th Congress oft the European Society for Sexual Medicine in Lyon/France. He was able to get 20 ED patients, average age 56.1 with an average of 35 months suffering from the symptoms, to participate in a pilot study. During this study he treated five different spots on their penis shaft with shock waves (intensity 0.09 mi/mm2) for three minutes each. This included only test persons with presumably damaged vessels, excluding neural, psychogenic and postoperative causes for their ED. Each treatment took three weeks, covered two sessions per week and was repeated after a three-week therapy-free interval.

In 14 out of 20 patients, the symptoms improved significantly: When in the beginning of the study, their values were between 12 and 20 points according to the “International Index of Erectile Function – Erectile Dysfunction (IIEF-ED)”, these increased with the shock wave therapy significantly by an average of 6.3 points (p equals 0.001). Parameters of the nocturnal penis tumescence (NPT) developed positively in 15 of 20 test persons which concerned most of all the duration of the erection and its rigidity. According to the director of studies there were no undesirable side effects.

Shock waves have a vessel-stimulating power

Vardi attributes this success to the fact that shockwaves are supposed to support the genesis of vessels. Indeed there is accumulating evidence in this direction. For example a working group at the Tohoku University Graduate School of Medicine in Japan recently demonstrated that weak shock waves – at about one tenth measure of the energy applied for urolithiasis – promotes the expression of endothelial growth factors. The Japanese succeeded in thus improving myocardial blood circulation.

That’s why the Israeli physician makes it absolutely clear that his therapy approach is only suitable for men with a weakness of undisputed vascular cause. And for this group, shock wave therapy might develop into one of the very few non-drug therapy options according to Vardi’s evaluation. Additional studies are now done to provide further data.

It is exactly those additional studies, Prof. Dr. Frank Sommer, Professor for men’s health at the University Hospital Hamburg Eppendorf is now demanding as well. Although he considers Vardi’s experiments an “interesting approach” but he criticizes the lack of a control group. “Further scientifically controlled studies with a larger patient collective have to confirm Mr. Vardi’s positive effect, prior to getting enthusiastic”, the Hamburg physician reacts carefully. Similarly restrained is the reaction of Prof. Dr. Sabine Kliesch, chief of medicine at the clinical andrology of the University Hospitals Muenster/Germany and secretary of the German Association for Urology (DGU). Extracorporal shockwaves supposedly had achieved positive effects during uncontrolled studies. “As soon as there was a placebo-controlled study made, the effects were unverifiable”, says the physician and thus is “extremely reluctant with a positive assessment”.